EmailMeForm
Credit Card Authorization
Thank you for choosing Dynamic Journeys Travel to plan and book your upcoming vacation.To secure your reservation with a deposit, pay for your vacation in full, or make payment on an existing reservation, please fill out and submit the form below.
If you are unsure of the deposit amount you need to authorize to secure a new reservation, please contact your travel professional for assistance.
Your statement will reflect the vendor (ie, Disney, Funjet) that was used to purchase your vacation.
I have accepted the proposal given to me by Dynamic Journeys Travel and am aware of any cancellation policies and travel requirements (passports, visas, etc.) By completing this form, I hereby authorize Dynamic Journeys Travel, an affiliate of KHM Travel Group, and their suppliers use of the following credit card information on my behalf for services quoted and accepted.
Credit Card:
*
Visa
Mastercard
American Express
Discover
Disney Visa
Amount to be charged today: $USD
*
Name as it appears on credit card
*
Billing Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Must be the same address used for credit card billing.
Billing Phone
*
###
-
###
-
####
Email
*
Credit Card
Card Number
Expiration
MM
/
YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
Protected in vault
Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Today's Date
MM
/
DD
/
YYYY
Vacation Quote I.D. Or
Brief Trip Description:
Brief description of your vacation: example
Smith's Honeymoon to St. Lucia.
Payment Type?
*
Deposit on a new reservation
Full Balance Due
Payment on an existing reservation
Hotel/Resort Guarantee (Pay at hotel or resort)
SSL ENCRYPTED
I have reviewed all trip details and confirm that all information is correct. Any alterations to the trip may result in extra fees. I agree that the names and birthdays I supplied to Dynamic Journeys Travel are exactly as they appear on my/our passports/government-issued IDs. I am aware of the cancellation policy for the supplier of this package. I acknowledge that I am purchasing this trip from a travel agent and not airline/hotel directly therefore transaction can’t be canceled due to flight/hotel service dissatisfaction.
*
Yes, I agree
I guarantee and warrant that I am the legal cardholder of this credit card *
*
Yes, I agree
I authorize Dynamic Journeys Travel to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described in the proposal ID referenced above, for the amount indicated above only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; as long as the transaction corresponds to the terms indicated in this form. *
*
Yes, I agree
Signature
Use your mouse or finger to sign here.
*
Clear
Type Signature Here
*